Refelctionsand Creations Dr. Shriniwas Kashalikar
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The document discusses reflections and creations, and how they can provide both pleasure and horror. It notes that people commonly enjoy watching their mirror image and receiving compliments, and performers enjoy audiences' applause. Creations like successful surgeries or films can also boost those who made them. However, sometimes reflections and creations show horrifying failures, which an abstract thinker working to help the world may face in lack of or distorted reflections and creations. The document poses whether namasmāran, or remembrance of the divine name, could help such people, suggesting it is worth trying.
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Pharmacology of Prostaglandins, Thromboxanes and Leukotrienes
This presentation gives information on the pharmacology of Prostaglandins, Thromboxanes and Leukotrienes i.e. Eicosanoids. Eicosanoids are signaling molecules derived from polyunsaturated fatty acids like arachidonic acid. They are involved in complex control over inflammation, immunity, and the central nervous system. Eicosanoids are synthesized through the enzymatic oxidation of fatty acids by cyclooxygenase and lipoxygenase enzymes. They have short half-lives and act locally through autocrine and paracrine signaling.
Breast cancer: Post menopausal endocrine therapy
Breast cancer in postmenopausal women with hormone receptor-positive (HR+) status is a common and complex condition that necessitates a multifaceted approach to management. HR+ breast cancer means that the cancer cells grow in response to hormones such as estrogen and progesterone. This subtype is prevalent among postmenopausal women and typically exhibits a more indolent course compared to other forms of breast cancer, which allows for a variety of treatment options.
Diagnosis and Staging
The diagnosis of HR+ breast cancer begins with clinical evaluation, imaging, and biopsy. Imaging modalities such as mammography, ultrasound, and MRI help in assessing the extent of the disease. Histopathological examination and immunohistochemical staining of the biopsy sample confirm the diagnosis and hormone receptor status by identifying the presence of estrogen receptors (ER) and progesterone receptors (PR) on the tumor cells.
Staging involves determining the size of the tumor (T), the involvement of regional lymph nodes (N), and the presence of distant metastasis (M). The American Joint Committee on Cancer (AJCC) staging system is commonly used. Accurate staging is critical as it guides treatment decisions.
Treatment Options
Endocrine Therapy
Endocrine therapy is the cornerstone of treatment for HR+ breast cancer in postmenopausal women. The primary goal is to reduce the levels of estrogen or block its effects on cancer cells. Commonly used agents include:
Selective Estrogen Receptor Modulators (SERMs): Tamoxifen is a SERM that binds to estrogen receptors, blocking estrogen from stimulating breast cancer cells. It is effective but may have side effects such as increased risk of endometrial cancer and thromboembolic events.
Aromatase Inhibitors (AIs): These drugs, including anastrozole, letrozole, and exemestane, lower estrogen levels by inhibiting the aromatase enzyme, which converts androgens to estrogen in peripheral tissues. AIs are generally preferred in postmenopausal women due to their efficacy and safety profile compared to tamoxifen.
Selective Estrogen Receptor Downregulators (SERDs): Fulvestrant is a SERD that degrades estrogen receptors and is used in cases where resistance to other endocrine therapies develops.
Combination Therapies
Combining endocrine therapy with other treatments enhances efficacy. Examples include:
Endocrine Therapy with CDK4/6 Inhibitors: Palbociclib, ribociclib, and abemaciclib are CDK4/6 inhibitors that, when combined with endocrine therapy, significantly improve progression-free survival in advanced HR+ breast cancer.
Endocrine Therapy with mTOR Inhibitors: Everolimus, an mTOR inhibitor, can be added to endocrine therapy for patients who have developed resistance to aromatase inhibitors.
Chemotherapy
Chemotherapy is generally reserved for patients with high-risk features, such as large tumor size, high-grade histology, or extensive lymph node involvement. Regimens often include anthracyclines and taxanes.
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Refelctionsand Creations Dr. Shriniwas Kashalikar
- 2. Watching in mirror is common. The assurance and reassurance our mirror image gives is familiar. The comfort and sense of elation and euphoria one gets; after listening to words of compliments is experienced by most of us. Watching the expressions of appreciation in the eyes of acquaintances is liked by most of us. The performers enjoy audiences’ applaud, so much that it becomes their lifeline. The pleasure of watching ourselves on TV or
- 3. listening ourselves on radio is common. We get boosted by our creations also. For example, a surgeon feels gratified to see successful results of his surgery. A cinema producer feels sense of achievement on seeing his or her own successful film. A musician, a painter, a sculptor, an architect and most of us feel great by our small or big successful creations! If not all these, we feel satisfied to see our progeny!
- 4. In short, it is revitalizing experience to see ourselves in one thing or the other. But sometimes and more often we see horrifying failures in our reflections and creations. An abstract thinker working for the welfare of the world is faced with lack or distortion of reflections and creations! It is even more horrifying! Can NAMASMARAN help such people? Well! It is worth trying and verifying.